Approved consistent with HHS' memos of 4/16/99 and 4/20/99. In addition, the following terms apply: (1) HHS will make every effort to modify the background information form (BIF) in those circumstances where burden can be minimized due to duplication between the BIF and information collected by the TANF agency and/or WtW data used for intake and reporting purposes. In assessing whether or not to modify the BIF, HHS will ensure that burden on respondents is minimized. (2) In order to minimize burden on respondents HHS will make the following changes to the forms: (a) limit information that is repeated on both the BIF and the contact information form (CIF) to only those data elements necessary for identification purposes. Thus, HHS will limit the repeated information to name and SSN only, (b) reduce the amount of *relative and friends* contacts requested on the CIF from four to three. (3) HHS will, following the completion of the selection of impact sites, but not later than 12/31/99, resubmit for OMB review, a revised table on *Minimal Detectable Impacts* (see Table 4 on page 21 of the supporting statement) that reflects the actual sample sizes achieved by HHS. (4) HHS will collect, at baseline, information on whether the individual requires substance abuse treatment. HHS, in order to minimize burden, will first attempt to collect this information from intake records, and if the intake records do not provide sufficient information on this issue, through a revision to the BIF.
Inventory as of this Action
Requested
Previously Approved
04/30/2002
04/30/2002
10,000
0
0
1,245
0
0
0
0
0
These data collection forms will allow for the collection of baseline information on all those enrolled in the analysis sample for the impact study component of the evaluation. The baseline data is critical to understanding the impacts of WtW services and will support later follow-up surveys of the impact study sample.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Baseline Data Collection Forms for the Multi-Site Evaluation of the Welfare-to-Work Grants Program